decision making

In an effort to address the opioid epidemic, a prominent goal of current research is to identify alternative treatments with equal or better benefits for pain while avoiding potential unintended consequences that could result in harms.

This 'living' systematic review assesses the effectiveness and harms of cannabis and other plant-based treatments for chronic pain conditions. For the purposes of this review, plant-based compounds (PBCs) included are those that are similar to opioids in effect and that have the potential for addiction, misuse, and serious adverse effects; other PBCs such as herbal treatments are not included. The intended audience includes policy and decision makers, funders and researchers of treatments for chronic pain, and clinicians who treat chronic pain.

The report will be updated on a quarterly basis.

Author/s:

McDonagh, M. S., Wagner, J., Ahmed, A. Y., Fu, R., Morasco, B., Kansagara, D., Chou, R.

Managing Opioid Use Disorder in Primary Care: PEER Simplified Guide

Bethie Seay — Mon, 13 Sep 2021 05:00:00 +0000

Date Added:

September 13, 2021

Type:

Meta-analyses, Reviews, and Guidelines

PMID (1):

31088869

MeSH

decision making

disease management

Humans

Opiate Substitution Treatment

opioid-related disorders

primary health care

A easy-to-use, primary care-oriented opioid use disorder management guideline from the College of Family Physicians of Canada.

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Objective: To use the best available evidence and principles of shared, informed decision making to develop a clinical practice guideline for a simplified approach to managing opioid use disorder (OUD) in primary care.

Methods: Eleven health care and allied health professionals representing various practice settings, professions, and locations created a list of key questions relevant to the management of OUD in primary care. These questions related to the treatment setting, diagnosis, treatment, and management of comorbidities in OUD. The questions were researched by a team with expertise in evidence evaluation using a series of systematic reviews of randomized controlled trials. The Guideline Committee used the systematic reviews to create recommendations.

Recommendations: Recommendations outline the role of primary care in treating patients with OUD, as well as pharmacologic and psychotherapy treatments and various prescribing practices (eg, urine drug testing and contracts). Specific recommendations could not be made for management of comorbidities in patients with OUD owing to limited evidence.

Conclusion: The recommendations will help simplify the complex management of patients with OUD in primary care. They will aid clinicians and patients in making informed decisions regarding their care.

Author/s:

Korownyk, C., Perry, D, Kolber, M. R., Garrision, S., Thomas, B., Allan, G. M., Bateman, C., de Queiroz, R., Kennedy, D., Lamba, W., Marlinga, J., Mogus, T., Nickonchuk, T., Orrantia, E., Reich, K., Wong, N., Dugré, N., Lindblad, A. J.

Patient Questions Surrounding Mask Use for Prevention of COVID-19 and Physician Answers from an Evidence-Based Perspective: a Narrative Review

Bethie Seay — Fri, 03 Sep 2021 05:00:00 +0000

Date Added:

September 3, 2021

Type:

Patient Education Materials

DOI (1):

10.1007/s11606-020-06324-w

MeSH

Evidence-based answers to patients’ questions about masks to prevent the spread of COVID-19.

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Recent mandates to wear masks in public places across the USA combined with conflicting messaging from the media and government agencies have generated a lot of patient questions surrounding the appropriate use and efficacy of cloth masks. Here, we have organized the evidence in the context of real patient questions and have provided example answers from a physician’s perspective. The purpose of this review is to offer healthcare providers with examples of how to respond to patient questions about masks in a way that encourages responsible decision-making. We conclude, based on the evidence showing a benefit for cloth masks and the recent reports supporting a role for aerosols in the transmission of SARS-CoV-2, that cloth masks will be effective when used correctly. We further assert that stronger public messaging surrounding cloth masks in the community setting is needed, and should specify that 2–3 layer, fitted face masks be worn at all times in public as another layer of protection in addition to social distancing, not just when social distancing cannot be maintained.

Author/s:

Martinez, J. A., Miller, R. H., Martinez, R. A.

Update to U.S. Selected Practice Recommendations for Contraceptive Use: Self-Administration of Subcutaneous Depot Medroxyprogesterone Acetate

Saige Blanchard — Fri, 21 May 2021 05:00:00 +0000

Date Added:

May 21, 2021

Journal/Publication:

Morbidity and Mortality Weekly Report

Publisher:

Centers for Disease Control and Prevention

Publication Date:

May 21, 2021

Issue:

Volume:

Pages:

739-743

URL:

Update to U.S. Selected Practice Recommendations for Contraceptive Use: Self-Administration of Subcutaneous Depot Medroxyprogesterone Acetate

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.15585/mmwr.mm7020a2

Keywords

PMID (1):

34014910

MeSH

Medroxyprogesterone Acetate

Contraceptive Agents

Surface Plasmon Resonance

Contraception Behavior

Patient Preference

decision making

Guidance from the CDC on self-administered depo-medroxyprogesterone acetate for contraception. James W. Mold, MD, MPH

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U.S. Selected Practice Recommendations for Contraceptive Use (U.S. SPR), adapted by CDC from global guidance developed by the World Health Organization (WHO), provides evidence-based guidance on contraceptive use for U.S. health care providers (1). During January-February, 2021, CDC evaluated the 2019 WHO recommendation on self-administered subcutaneous depot medroxyprogesterone acetate (DMPA-SC) (2). CDC adopted the WHO recommendation on the basis of moderate-certainty evidence that self-administered DMPA-SC is safe and effective, and has higher continuation rates compared with provider-administered DMPA. The new U.S. SPR recommendation states that self-administered DMPA-SC should be made available as an additional approach to deliver injectable contraception. Provider-administered DMPA should remain available. Self-administered DMPA-SC is a user-controlled method that has the potential to improve contraceptive access and increase reproductive autonomy. Self-administered DMPA-SC should be offered in a noncoercive manner through a shared decision-making process between patients and their health care providers, with a focus on patient preferences and equitable access to the full range of contraceptive methods.

Author/s:

Curtis, K. M., Nguyen, A., Reeves, J. A., Clark, E. A., Folger, S. G., Whiteman, M. K.

Contraceptive Challenges in Women With Common Medical Conditions

Brian Desmarais — Sat, 07 Nov 2020 21:17:24 +0000

Date Added:

November 7, 2020

Journal/Publication:

Mayo Clinic proceedings

Publisher:

Mayo Clinic

Publication Date:

November 1, 2020

Issue:

Volume:

Pages:

2525-2534

URL:

Contraceptive Challenges in Women With Common Medical Conditions

Format:

Article

DOI (1):

10.1016/j.mayocp.2020.08.045

MeSH

health personnel

reproduction

Contraceptive Devices

Recommendations for contraception in patients with a variety of medical conditions. James W. Mold, MD, MPH

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Women have the opportunity to meet personal contraceptive goals with convenient, highly reliable, and easily reversible methods. Long-acting reversible contraception represents an increasingly popular option for most women throughout the reproductive lifespan. Nonetheless, many women and their health care providers are challenged by coexisting medical issues. We aim to help clinicians individualize contraception and use shared decision-making to enhance patient satisfaction and continuation with their method.

Author/s:

Gave, C.J., Marnach, M.L., Casey, P.M.

Patient-Reported Needs Following a Referral for Colorectal Cancer Screening

Brian Desmarais — Tue, 29 Sep 2020 13:30:42 +0000

Date Added:

September 29, 2020

Journal/Publication:

American Journal of Preventive Medicine

Publication Date:

February 1, 2019

URL:

Patient-Reported Needs Following a Referral for Colorectal Cancer Screening

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1016/j.amepre.2018.08.017. Epub 2018 Dec 13.

MeSH

decision support techniques

early detection of cancer

Physician-Patient Relations

patient acceptance of healthcare

Patients referred for colonoscopy have lots of questions that are not always being answered by primary care clinicians. Many would appreciate being able to access additional information through the the practice’s portal. James W. Mold, MD, MPH

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Abstract

Introduction: Patient-physician communication about colorectal cancer screening can affect screening use, but discussions often lack information that patients need for informed decision making and seldom address personal preferences or barriers. To address this gap, a series of patient focus groups was conducted to guide the development of an online, interactive decision support program. This article presents findings on patient information needs and barriers to colorectal cancer screening after receiving a screening recommendation from a physician, and their perspectives on using electronic patient portals as platforms for health-related decision support.

Methods: Primary care patients with recent colonoscopy or stool testing orders were identified via the centralized data repository of a large Midwestern health system. Seven gender-stratified focus groups (N=45 participants) were convened between April and July 2016. Sessions were audio recorded, transcribed, coded, and analyzed for commonly expressed themes beginning in August 2016.

Results: Findings reveal a consistent need for simple and clear information on colorectal cancer screening. Participants desired step-by-step explanations of the colonoscopy procedure and information about bowel preparation options/alternatives. The desired level of additional information varied: some patients wanted to know about and act on test options, whereas others preferred following their physician-recommended testing path. Fears and concerns were prevalent, particularly about colonoscopy, and patients reported challenges getting these concerns and their informational needs addressed. Finally, they expressed consistent support for using the patient portal to gather additional information from their physician.

Conclusions: Patient portals may offer an opportunity to build sustainable programs for decision support and assistance that are integrated with clinic workflows and processes.

Trial registration: ClinicalTrials.gov NCT02798224.

Author/s:

Dyer, Karen E., Shires, Deirdre A.

Canadian guideline for Parkinson disease

Brian Desmarais — Mon, 03 Feb 2020 17:28:55 +0000

Date Added:

February 3, 2020

Journal/Publication:

Canadian Medical Association Journal

Publication Date:

September 9, 2019

Issue:

Volume:

191

Pages:

E989-E1004

URL:

Canadian guideline for Parkinson disease

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1503/cmaj.181504

MeSH

Hospice and Palliative Care Nursing

Parkinsonian Disorders

decision making

communication

Canada

Updated Canadian guidelines for management of Parkinson’s Disease. James W. Mold, MD, MPH

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KEY POINTS

This guideline update reflects substantial changes in the literature on diagnosis and treatment of Parkinson disease, and adds information on palliative care.
Impulse control disorders can develop in a person with Parkinson disease who is on any dopaminergic therapy at any stage in the disease course, especially for those taking dopamine agonists.
Advanced therapies like deep brain stimulation and intrajejunal levodopa-carbidopa gel infusion are now routinely used in Parkinson disease to manage motor symptoms and fluctuations.
Evidence exists to support early institution of exercise at the time of diagnosis of Parkinson disease, in addition to the clear benefit now shown in those with well-established disease.
Palliative care requirements of people with Parkinson disease should be considered throughout all phases of the disease, which includes an option of medical assistance in dying.

Author/s:

Grimes,D., Fitzpatrick, M., Gordon, J., Miyasaki, J., Fon, E.A., Schlossmacher, M., Suchowersky, O., Rajput, A., Lafontaine, A.L, Mestre, T., Appel-Cresswell, S., Kalia, S., Schoffer, K., Zurowski, M., Postuma, R.B., Udow, S., Fox, S., Barbeau, P., Hutton, B.

Screening for Colon Cancer in Older Adults: Risks, Benefits, and When to Stop

Brian Desmarais — Fri, 03 Jan 2020 19:11:46 +0000

Date Added:

January 3, 2020

Journal/Publication:

The Mayo Clinic Proceedings

Publication Date:

January 1, 2020

Issue:

Volume:

Pages:

184–196

URL:

Screening for Colon Cancer in Older Adults: Risks, Benefits, and When to Stop

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

https://doi.org/10.1016/j.mayocp.2019.02.021

Keywords

MeSH

A fair and balanced review of CRC screening in older people from Mayo. James W. Mold, MD, MPH

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Colorectal cancer (CRC) is the fourth leading cause of cancer and second leading cause of mortality from cancer in the United States. As the population ages, decisions regarding the initiation and cessation of screening and surveillance for CRC are of increasing importance. In elderly patients, the risks of CRC and the presenting signs and symptoms are similar to those in younger patients. Screening and ongoing surveillance should be considered in patients who have a life expectancy of 10 years or more. Life expectancy estimates can be calculated using online calculators. If screening is deemed appropriate, the choice of which test to use first is unclear. Currently, there are a number of modalities available to screen for CRC, including both invasive modalities (eg, colonoscopy, sigmoidoscopy, capsule colonoscopy, and computed tomographic colonography) and noninvasive modalities (fecal immunochemical test, stool DNA testing, and blood testing). Colonoscopy and other invasive testing options are considered safe, but the risks of complications of the bowel preparation, the procedure, and sedation medications are all increased in older patients. In contrast, noninvasive testing provides a safe initial test; however, it is important to consider the increased false-positive rates in the elderly, and a positive test result will usually necessitate colonoscopy to establish the diagnosis. Ongoing screening and surveillance should be a shared decision-making process with the patient based on multiple factors including the patient’s morbidity and mortality risk from CRC and his or her underlying comorbidities, the patient’s functional status, and the patient’s preferences for screening. Ultimately, the decision to initiate or discontinue screening for CRC in older patients should be done based on a case-by-case individualized discussion.

Author/s:

Nee, J., Chippendale, R. Z., Feuerstein, J.D.

Pharmacotherapy for Adults With Alcohol Use Disorder (AUD) in Outpatient Settings

Tracy Ashby — Fri, 07 Dec 2018 06:00:00 +0000

Date Added:

December 7, 2018

Journal/Publication:

AHRQ Comparative Effectiveness Reviews

Publisher:

Agency for Healthcare Research and Quality

Publication Date:

February 16, 2016

URL:

Pharmacotherapy for Adults With Alcohol Use Disorder (AUD) in Outpatient Settings

Type:

Meta-analyses, Reviews, and Guidelines, Meta-analyses, Reviews, and Guidelines

Format:

Article

Keywords

alcohol use disorder

pharmacotherapy

patient care

PMID (1):

26937549

MeSH

alcoholism

caregivers

decision making

This is a summary of the current evidence on medication-assisted treatment of alcohol use disorder.

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Focus of This Summary

This is a summary of a systematic review evaluating the evidence regarding the efficacy, comparative effectiveness, and adverse effects of medications in adults with alcohol use disorder (AUD). The systematic review included 167 articles reporting on 135 eligible studies published from January 1, 1970, to October 11, 2013. This summary is provided to inform discussions with patients and/or caregivers of treatment options and to assist in decisionmaking along with consideration of a patient's values and preferences. However, reviews of evidence should not be construed to represent clinical recommendations or guidelines.

Author/s:

John M. Eisenberg Center for Clinical Decisions and Communications Science